| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
4,616 |
4,151 |
$800K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
948 |
787 |
$96K |
| A4554 |
Disposable underpads, all sizes |
645 |
586 |
$36K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
116 |
113 |
$14K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
236 |
208 |
$6K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
50 |
48 |
$6K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
39 |
36 |
$4K |
| E0570 |
Nebulizer, with compressor |
28 |
28 |
$4K |
| A4930 |
Gloves, sterile, per pair |
54 |
49 |
$3K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
12 |
12 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
235 |
206 |
$426.81 |